WATER TREATMENT PLANTS 1 AND 3 WELLFIELD EXPANSION PHASE 1 - WELL INSTALLATION - PROJECT NO. 07-0037-UT - CERTIFICATE OF LIABILITY INSURANCEJUL. U. LVV7 J.J4i vl U IJ7VUV7U7 [I V. -TJ +
ATM. CERTIFICATE OF LIABILITY INSURANCE DA 07,1,E
PRODUCER Phana• (913)888+1234 Fax: 0%-900-Mee THIS CERTIFICATE IS ISSUED AS A MATTER OF 1NFORN(ATION
ASSOCIATES AGENCY, INC_ ONLY AND GONFPE 2S NO RIGHTS UPON THE CERTIFICATE
PO Box 16196 HOLDER. THIS CrERTIFICATE DOES NOT AMEND, EXMD OR
11479 N- 63RD ST. ALTER THE COVEIRAGE AFFDRDED BY THE POLICIES BELOW.
TEMPLE TERRACE FL 33687
INSURED
SOUTHEAST DRILLING SERVICES INC.
P-O. BOX 2764
L.UTZ Fl. 33W
INSURERS AFFORDING COVERAGE
INSURER A' OWNS
INSURER 8: AUTO
INSURER C.
INSURER D:
INSURER E:
CO.
NAIC 0
32700
18988
THE POLICIES OF INSURANCE LISTER BELOW HAVE BEEN ISSUED TO THE INSLNM NAMED ABOVE FOR THE ROLICY PERIOD IN11CAYED, NOTWITHSTANGM
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NRTH RESPECT TO WM1CIi THIS CERTIFICATE MAY 56 ISSUED OR
MAY PERTAn, THE INSLRANCE AFFORDED BY THE POLICIES DESCRIBED HEREW IS SUILMY TO ALL 7HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED Ir Y RAID OLAAAS.
TYPE OF INSURANCE POLICY NUIIBBR FOLICYFFFECTIVE
Km POLICY =IOK
. LIMITS
GENERAL LABIUIIY 20709632 07101M 071ol114 EA OCCURRENce $ T,0D0,000
X COMA?RCIAL GENERAL LA6?JTY Rwm ¢a n = s SO,000
CLAIMS MADE I A I OCCUR MED. E%R (AIV Wm Perim) S 6,000
A PERSONAL 6 ADV INJURY S 1,000,000
GENERAL AGGREGATE 6 1 000 000
GEN'LAGGREGATELIMIT APPLIESQER PAODUCTS-COMFfOPAQG 3 1,000,000
PRO-
POLICY JECT LOG
AUT OMOBILE LIABILITY 4142994900 07/07/09 07101110 COMBINED SINGLE LIMIT
X ANYAUTO McQ;Wdam I: 1.000,000
ALL OWNED AUTOS BODILY WiLrmY
SCHEDULED AUTOS
E3 X NIR)=D AUTOS BODILY INJURY
X NON-OWNED AUTOS ' (Peraeckla" #
' RTY DAMAGE
PROPE
Per aeddSW g
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT #
ANY AVrQ OTHER THAN EA ACC S
AUTO ONLY' AGG 5
EXCESS I U111BRELLA WMILIYY 4346231701 07ADIIUS 07101Y10 EACM OCCURRENCE 3 5,000,000
X OCCUR F1 CLAIMSMADE AGGREGATE 6 5,000,000
B Z
DEDUCTIBLE 3
RETENTION S 0 I S
SCOMPENSAnQNAND
W R 20640738 07109!09 07/01x10 X I =STATU,
RS
YO t eni O"ARTTERfIDECUTNE 151. EACH ACCIDENT # 500.000
B AN
OFF dNbM m" E L. NSE &EA EMPLOYEE S 600L)00
r Y&L u=Mm under
snECUU plsulASlaNa bduw
:
E L DISEASE-POUCY UNIT
# SOD,000
A OTFIETt INLAND MARINE
CONTRACTORS EQUIPMENT 20699978 07/01109 07101110 RENTED/LEASED EQUIPMENT
$100,000 151:4 $1,000
DESCRIPTION OF OPERATIONS/LOCATIONSMMICLF,B/FJCCLUSIONS ADDED BY ENDORSeMENT/ SPECIAL PROVISIONS
Project: WTP 1 & 3 WallReld E xpamio" Phase I
City of Clearwater pnDjm #07.0037-UT
The City of Clearwater and any others required by contract are additional insureds under thei general liability and auto liability policies. All
PDllaies provide a waiver of subrogation In favor of t" additional Insureds.
CI=RTIFIrAT'F MnI nrR r.ANrFI I ATInN 1
SHOULD ANY OF THE ANQVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREQF, YW ISSUING INSURER WILL ENOEAVCR TO MAIL 3D DAYS
WRIREN NOTICE TO THE • CERTIFICATe HOLDER NAMED TO THE LEFT, BUT FAILURE
City of Clearwater TO DO 90 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.
100 S. Myrtle Avenue, suit®,0210 173 AGENTS OR REPRESENITATNES
Clearwater, FI 33755
AUTHOR EPFIESENTAT?
Attentkrtt: 727482.6989
ACORD 25 (2001108) CeRIFIoe110111 160727 11r ?/ Q) ACQRO CORPORATION 1988